Author Information

John Gardner,

Evan Ownby,

Stanley Taylor,

Changyu Shen and

Ronald Mastouri

Background

Transesophageal echocardiography (TEE) is a valuable tool to diagnose infective endocarditis in the setting of bacteremia. However, little information exists to guide the use of TEE in bacteremic patients. We identify low risk patients where TEE does not provide additional diagnostic information.

Methods

Retrospective analysis of all patients with bacteremia who underwent TEE to rule out endocarditis from November 2009 to October 2012. Patients were classified as low risk for endocarditis on TEE if the following risk factors were absent:

1. Congenital heart disease

2. Prior valve replacement

3. End–stage renal disease

4. Prior endocarditis

5. Intravenous drug abuse

6. Evidence of embolism

7. Moderate or severe valvular lesions on transthoracic echo (TTE)

Results

A total of 350 TEEs were reviewed. 83 patients (24%) were identified as low risk. Odds ratios for finding endocarditis on TEE were calculated for each risk factor. A low risk screen with no risk factors had a sensitivity of 98.5% and a negative predictive value of 98.8% for TEE findings of endocarditis.

Conclusion

This data presents a novel, efficient and sensitive risk stratification algorithm for the presence of endocarditis on TEE. Use of this screening test can help avoid TEEs that do not yield additional diagnostic information and spare patients the associated risks and costs. Application of these criteria could have reduced low–yield TEEs by 24% in our patients.

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